What the heck is rheumatology?

When I meet someone for the first time and tell them that I’m a rheumatologist, I usually get blank stares, as if I had spoken to them in a foreign language. It doesn’t matter if they are a medical student, family member, or even an immigration officer. It doesn’t matter if they have a Ph.D. or they are a high school dropout. I even see patients in my rheumatology clinic who have no idea what rheumatology is, nor how I’m supposed to help them.

I can’t blame them. Rheumatology is a weird field. Just look at the origin of the word “rheumatology.” The prefix “rheuma,” meaning “to flow,” was first used by a Greek physician 2000 years ago, referring to the phlegm that flows from the nose when a person is ill. But rheumatology, as it is practiced today, has nothing to do with phlegm (talk about false advertising!). Cardiologists don’t have this identity problem because they, of course, manage the heart. Dermatologists treat your skin. Proctologists…well, you get the picture.

A quick web search about rheumatology is not fruitful either. Rheumatology is defined as: “the medical specialty that manages rheumatic diseases.” My rheumatology textbook doesn’t even try to define what field is all about.

In addition, we’re not a popular specialty. I don’t know of one famous rheumatologist. We’re not usually in the news. We’re not the heroes in any movie. In fact, I don’t think I’ve ever seen a TV character who is a rheumatologist (even though there is at least one paleontologist on TV!). The TV character that most closely approximates what a rheumatologist does is my hero Dr. House (no relation, unfortunately) on the TV show House, MD. He is actually board certified in nephrology and infectious diseases, but he gets consulted on very complicated cases, much like rheumatologists often do. However, he’d make a lousy rheumatologist because, according to him, “it’s never lupus!”

As I see it, rheumatology is the study of inflammation (swelling, redness, warmth, and pain) occurring in the structures that hold up the body, such as the bones, muscles, and joints. Arthritis, or inflammation of the joints, is the most common disease that we see, both in children and adults (kids get arthritis too!). Arthritis comes in a variety of flavors, including juvenile, rheumatic, psoriatic, gouty, osteoarthritis, etc..

We also take care of complex diseases such as systemic lupus erythematosus, systemic sclerosis, and dermatomyositis, in which the immune system attacks various different organs. Vasculitis, or inflammation of a blood vessel, is another disease which we treat. Other strange illnesses (with even stranger names) such as Kawasaki disease, Sjögren syndrome, and relapsing polychondritis are all within the field of rheumatology.

Most of the above-mentioned diseases are considered autoimmune, in which the immune system loses the ability to recognize self from non-self. When a cell of the immune system passes through the kidney, it should be able to recognize it and say: “Hello! You are my kidney, I will protect you against infections!” However, in autoimmune diseases, the immune cell gets confused and says: “Whoa! What is this bean-shaped organ doing here? You look foreign, I will fight you to the death!” As a result, the immune cell begins a process of inflammation that causes organ damage. Many different organs can be affected in autoimmune diseases, and the name of the disease depends on which organ is affected.

At the other end of the rheumatology spectrum are autoinflammatory diseases (my favorite!). These diseases occur when the machine that produces inflammation goes awry. Immune cells are tightly regulated to produce inflammation only when needed (such as in response to a microbe or to damaged tissue). However, in most autoinflammatory diseases, there is a mutation in the inflammation machine that causes it to produce inflammation at inappropriate times. The immune cell in autoinflammatory diseases says: “Darn, I’m leaking inflammatory fluid yet again!” Thus, the patient develops episodes of fevers, rashes, and joint pain without any other explanation.

As you can see, rheumatologists manage a wide variety of illnesses that affect many different organs. Most of these diseases do not have clear causes, which makes rheumatology a fascinating field to study. At least until a smart marketing team comes up with a better name for our specialty (I vote for “inflammatology!”), you won’t have to look at me weird when I tell you what I do for a living.

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Great post. The medical students I teach have a real problem getting there head around what they are meant to be learning about, let alone actually learning about the actual diseases. The other classic illustration of the poor understanding of our specialty is the referral letter that comes through every so often – “Please see this patient. I think they have something rheumatolgical” – I kid you not! Keep up the great work – Rebecca (Adult Rheumatologist, New Zealand)

Rebecca, thank you for your comments. Like you, I’ve also struggled with teaching rheumatology…there is a lot of uncertainty in our specialty that is difficult for students to understand. I also think we deal with abstract, complex diseases that are difficult to grasp (unlike, say, a broken bone, a clogged artery, etc).
I can relate with you regarding the consults to “rule out rheumatologic disease.” I think part of this stems from our failure to teach our colleagues about our field (and that it’s not just about ordering ANA and RF!).

I enjoyed reading this blog. I have Ankylosing Spondylitis and I think medical students would benefit by inviting patients to teaching sessions so that students can learn about symptoms such as joint pain, stiffness, and fatigue.

I think that’s a great idea! Since AS and other rheumatologic diseases are fairly rare, it’s possible that students go through medical school without ever meeting a patient with AS. Inviting patients with these rare disorders to speak to students would help to solve this problem….

Well I don’t know what I have yet 🙂
My Dr. Just told me today that my arthritis blood work came back negative… but it does show some sort of… I can’t remember what word she used… I want to say… swelling… she said it shows there is something causing swelling going through???… so waiting on referral to see a rheumatologist

Thank you for this post. i never did understand what rheumatology was even though my mother-in-law was treated by a rheumatologist and died of complications from a disease treated by a rheumatologist. My daughter has yet to be diagnosed, but I’m going to ask for a referral to a rheumatologist/inflammatologist..I hope she didn’t inherit a genetic predisposition from her grandmother…
She is only 25 and she can’t walk without a special boot with inflatable pads inside..and she can’t use her hands on a laptop. We are besides ourselves. She is in so much pain.

She said she has been screened for arthritis..but I suspect some inflammation of the auto-inflammatory sort underlies her mobility and use of her limbs.

We live in Canada and have been to so many specialists..I do believe a good rheumatologist will find the source of the problem….I hope it is treatable. all she does is ice and go to massage and physiotherapy, athletic therapy…

Thanks for your comments. Rheumatologists deal with weird diseases, so it’s no surprise why most people don’t understand what it’s all about. I was in medical school the first time I heard of a rheumatologist!

Rheumatologists are experts at diagnosing fibromyalgia, especially in differentiating this condition from other illnesses that also cause joint and muscle pain. However, not every rheumatologist is an expert at treating this condition. Some will refer fibromyalgia patients back to the PCP, others will send patients to pain medicine docs, others will treat fibromyalgia patients themselves. Before seeing a rheumatologist, I suggest that you call their office and ask if the rheumatologist treats fibromyalgia.

Thank you for this great article! I am a final year medical student studying in London, England and found this article enlightening. I do however have one further query; what is the actual origin of the name Rheumatology? As in why is your speciality named Rheumatology and when were all the various diseases you treat clumped together under the umbrella of Rheumatology? I have been trying to get to the bottom of this and come up short with my Google searches. I appreciate the etymology of the word Rheumatology but was more looking for something on how the speciality actually came to have this particular and peculiar name.
Many thanks